{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:56:25Z","timestamp":1781272585409,"version":"3.54.1"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HI18C1169"],"award-info":[{"award-number":["HI18C1169"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Although scoliosis is essentially a three-dimensional (3D) deformation of the spine and has been reported to be associated with muscle activations around the vertebrae, no study has demonstrated the 3D structural deformations of the spine in relation to asymmetrical muscle activation nor revealed the neuromuscular characteristics associated with scoliosis. The purpose of this study was to investigate the association between asymmetrical muscle activation and three-dimensional spinal deformity in adolescent idiopathic scoliosis (AIS) of thoracic origin. Methods: Thirty-one patients with IS of thoracic origin (double major [DM] and single thoracic [ST] types) and 39 normal controls were included. Surface electromyographic (SEMG) signals were obtained in several back muscles while the patients were in a writing posture. 3D analyses of spinal curves with EOS imaging system were performed, and \u201cAR_main\u201d (indicative of axial rotation of the vertebral column), \u201c\u0394AR\u201d (indicative of lateral bending), and \u201cAK_max\u201d (indicative of maximal angle of kyphosis) were evaluated. Results: Asymmetrical activations were observed in the middle trapezius with rhomboids, and the T6-7 and T12 paraspinalis muscles, with higher activation on the convex side of the scoliosis curve. On EOS 3D analysis, \u201cAR_main\u201d was 8.94\u00b0 [IQR, 0.00\u201314.00] and 26 of 31 patients had AR_main \u2265 0\u00b0. \u201c\u0394AR\u201d was 21.90\u00b0 [IQR, 6.00\u201339.00]. As the AR_main increased, the Cobb angle became closer to the maximal angle of kyphosis (\u201cAK_max\u201d). Conclusions: Asymmetrical activations of several back muscles while patients were in a writing posture were observed. These asymmetrical muscle activation patterns were associated with axial rotation and lateral bending of the thoracic spine in patients with thoracic-origin AIS.<\/jats:p>","DOI":"10.3390\/jcm15020784","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Asymmetrical Muscle Activation and Three-Dimensional Spinal Deformity in Thoracic-Origin Idiopathic Scoliosis Assessed Using Surface Electromyography and EOS Imaging"],"prefix":"10.3390","volume":"15","author":[{"given":"Sunmok","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Hyun","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul 07985, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwoon","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seosong Hospital, Incheon-si 21043, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungeun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changwon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seon","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Chang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaewon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Seok","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth","volume":"13","author":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1227\/01.NEU.0000320427.28377.F7","article-title":"Idiopathic scoliosis","volume":"63","author":"Angevine","year":"2008","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/BPO.0000000000001808","article-title":"Trends in Incidence of Adolescent Idiopathic Scoliosis: A Modern US Population-based Study","volume":"41","author":"Thomas","year":"2021","journal-title":"J. Pediatr. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00586-011-1695-8","article-title":"Idiopathic scoliosis in Korean schoolchildren: A prospective screening study of over 1 million children","volume":"20","author":"Suh","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1016\/j.apmr.2020.09.196","article-title":"Two Different Mechanisms of Adolescent Idiopathic Scoliosis: Asymmetrical Hyperactivation and Asymmetrical Weakness","volume":"101","author":"Park","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.clinbiomech.2015.03.018","article-title":"Electromyographic activity of erector spinae and external oblique muscles during trunk lateral bending and axial rotation in patients with adolescent idiopathic scoliosis and healthy subjects","volume":"30","author":"Farahpour","year":"2015","journal-title":"Clin. Biomech."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s00586-004-0780-7","article-title":"A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis","volume":"14","author":"Cheung","year":"2005","journal-title":"Eur. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/BF00298367","article-title":"Imbalance of electromyographic activity and physical rehabilitation of patients with idiopathic scoliosis","volume":"1","author":"Weiss","year":"1993","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"304","DOI":"10.3109\/17453678408992362","article-title":"Electromyography of the paravertebral muscles in idiopathic scoliosis: Measurements of amplitude and spectral changes under load","volume":"55","author":"Zetterberg","year":"1984","journal-title":"Acta Orthop. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"958450","DOI":"10.1155\/2015\/958450","article-title":"Evaluation of Myoelectric Activity of Paraspinal Muscles in Adolescents with Idiopathic Scoliosis during Habitual Standing and Sitting","volume":"2015","author":"Kwok","year":"2015","journal-title":"Biomed Res. Int."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carson, V., Cliff, D.P., Janssen, X., and Okely, A.D. (2013). Longitudinal levels and bouts of sedentary time among adolescent girls. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-173"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Arundell, L., Salmon, J., Koorts, H., Contardo Ayala, A.M., and Timperio, A. (2019). Exploring when and how adolescents sit: Cross-sectional analysis of activPAL-measured patterns of daily sitting time, bouts and breaks. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6960-5"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/jor.1100070511","article-title":"Axial rotation component of thoracic scoliosis","volume":"7","author":"Stokes","year":"1989","journal-title":"J. Orthop. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1748-7161-3-16","article-title":"Vertebral rotation measurement: A summary and comparison of common radiographic and CT methods","volume":"3","author":"Lam","year":"2008","journal-title":"Scoliosis"},{"key":"ref_15","first-page":"169","article-title":"Correlation of an induced rotation model with the clinical categorisation of scoliotic deformity\u2014A possible platform for prediction of scoliosis progression","volume":"123","author":"Heidari","year":"2006","journal-title":"Stud. Health Technol. Inf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.otsr.2018.10.021","article-title":"The third dimension of scoliosis: The forgotten axial plane","volume":"105","author":"Illes","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1080\/10255842.2018.1564819","article-title":"Validation of an OpenSim full-body model with detailed lumbar spine for estimating lower lumbar spine loads during symmetric and asymmetric lifting tasks","volume":"22","author":"Robertson","year":"2019","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/1440-1630.12393","article-title":"Comprehension of handwriting development: Pen-grip kinetics in handwriting tasks and its relation to fine motor skills among school-age children","volume":"64","author":"Lin","year":"2017","journal-title":"Aust. Occup. Ther. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1589\/jpts.30.324","article-title":"The effect of fine motor skills on handwriting legibility in preschool age children","volume":"30","author":"Seo","year":"2018","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.12659\/MSM.902455","article-title":"Volumetric and Fatty Infiltration Imbalance of Deep Paravertebral Muscles in Adolescent Idiopathic Scoliosis","volume":"23","author":"Jiang","year":"2017","journal-title":"Med. Sci. Monit."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3146","DOI":"10.1007\/s00586-016-4628-8","article-title":"Electrophysiological and histological changes of paraspinal muscles in adolescent idiopathic scoliosis","volume":"25","author":"Stetkarova","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00007632-199002000-00001","article-title":"Handedness and scoliosis convexity: A reappraisal","volume":"15","author":"Goldberg","year":"1990","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1007\/s00586-014-3269-z","article-title":"Eye-hand laterality and right thoracic idiopathic scoliosis","volume":"23","author":"Catanzariti","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1080\/10428190500343027","article-title":"Trunk asymmetry and handedness in 8245 school children","volume":"9","author":"Grivas","year":"2006","journal-title":"Pediatr. Rehabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/784\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:46:46Z","timestamp":1768902406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020784"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020784","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]}}}